President Obama sold the Affordable Care Act aka Obama Care to the American people based on four promises. To gain public support for his landmark new entitlement, lacking bi-partisan support and whose content was unknown, the President pledged:

First pledge: Obama Care officials project that employers will pay $135 billion in fines to opt out of health insurance for their employees. You cannot keep your current insurance if your employer no longer offers it! In addition, twelve percent of insured employees will be forced into inferior plans by new taxes on their high-benefit coverage. Most covered by Medicare Advantage will lose it.

Conclusion: If you like your current insurance you are NOT assured you can keep it under Obama Care.

Second pledge: The Obama administration calculates that fifteen percent of Medicare Part A providers will become unprofitable under Obama Care. As administration health planners delicately put it: low reimbursement rates “might end (provider) participation and possibly jeopardize access to care by beneficiaries.” Translation: Your doctor might drop you like a hot potato. Private surveys reveal that a high percentage of physicians intend to retire early under Obama Care. Few currently accept Medicaid patients as is. As your doctor retires or will no longer accept you, you cannot keep your doctor.

Conclusion: If you like your current doctor, there is no assurance that you can keep him or her.

Third pledge: The $1.9 trillion estimated gross cost of Obama Care (2014-2023) is supposed to be offset by $624 billion in new penalties and excise taxes, leaving a net cost of $1.3 trillion. $1.3 trillion is not “less than a trillion.” The “array of technical, behavioral, and economic factors, some of which involve programs and institutions that do not yet exist” make the $1.3 trillion price tag “a source of great uncertainty,” admit Obama Care planners. The costs of Medicare and Medicaid were originally underestimated by factors of seven and nine, respectively. If Obama Care is underestimated by only a third as much, its price tag would be $4 trillion. Past experience suggests Obama Care’s price tag will be well above $1.3 trillion.

Conclusion: Obama Care is projected to cost $1.9 trillion in its first ten years, or $1.3 trillion after deducting its new taxes and penalties. The $1.3 trillion figure is likely to be an underestimate. The “less than a trillion” promise is an empty one.

Fourth pledge: Obama Care’s architects plan to offset its $1.3 trillion net cost by reducing payments to Medicare, Medicaid, and Chips by at least that amount to make the program deficit neutral. Although Obama Care expects minor savings from new technologies and productivity advances, it reduces Medicare, Medicaid and Chips costs principally by lowering reimbursements to physicians, nurses, hospitals, and home care providers and by scrapping subsidies to Medicare Advantage.

Conclusion: In order for Obama Care not to add to the deficit, it must reduce payments to Medicare, Medicaid, and Chips by some $1.3 trillion, at a minimum. Such reductions will not happen because they are politically unacceptable. If Obama Care achieves half of the planned Medicare, Medicaid and Chips savings, the deficit would increase by $633 billion. If Obama Care makes no reduction in Medicare, Medicaid and Chips costs, the deficit would increase by $1.3 trillion.

Although the Obama administration pays lip service to “Obama Care does not raise the deficit,” its own studies note that Congress has overridden reductions in payments to Medicare physicians for seven years straight, that the CLASS program for high-risk patients will succumb to the “insurance death spiral,” and “reductions in payment updates to health care providers, based on economy-wide productivity gains, are unlikely to be sustainable.”

To get a frame of reference for the $1.3 trillion in cuts: Between 2014 and 2018, an average of $80 billion in annual cost savings must be found for Medicare alone. That is double the current sequestered civilian discretionary spending that is closing White House tours, airport control towers, and meat inspections right now.

Imagine the politics of approving $80 billion in cuts for striking physicians and nurses demanding a “living wage” or for hospitals threatening to close their doors. Medical-device companies have already obtained a bi-partisan Senate resolution to repeal its Obama Care tax. The list of exemptions will grow exponentially. Only those poor saps without lobbying clout will actually pay up. With each exemption from cuts to Medicare, Medicaid, and Chips, the deficit will grow.

We have two choices: Repeal Obama Care before it is too late or continue down the road to an entitlement that threatens to bureaucratize (ruin) our health care system while running up a deficit, the size of which we can only imagine.

I find it strange that the media has not revealed that the President of the United States has not kept four solemn pledges to the American people. Obama Care was passed in a time of uncertainty and confusion. There was no real debate in Congress. We were told to pass the bill to see what is in it. In such times, we must have confidence that we can take the President at his word. In this case, we could not.

Other Presidents would have already expended their political capital if they failed to meet their solemn pledges. Barack Obama seems to be an exception, at least till now, but what will happen next time when he really needs the trust of the American people?

Update: Today's New York Times (Report Card on Health Care Reform) gives Obama Care an A plus report card, while noting it does not really go into effect until January 1, 2014. It credits Obama Care with young adults staying on the parents' insurance, opportunities to enroll with pre-existing conditions, slower rises in health care costs (due to the recession) and iiteresting experimental programs that may or may not work. Noteworthy for their absence -- no mention of Obama;s four unkept promises on which he sold Obama Care to the skeptical American people. I guess such things are best forgotten.

I am a research fellow at the Hoover Institution, at Stanford, and energy fellow and Cullen Professor of Economics at the University of Houston. I am also a research professor at the German Institute for Economic Research Berlin. My specialties are Russia and Comparative Ec...